Repositioning for pressure injury prevention in adults
Brigid M Gillespie, Rachel M Walker, Sharon L Latimer, Lukman Thalib, Jennifer A Whitty, Elizabeth McInnes & Wendy P Chaboyer
Background: A pressure injury (PI), also referred to as a 'pressure ulcer', or 'bedsore', is an area of localised tissue damage caused by unrelieved pressure, friction, or shearing on any part of the body. Immobility is a major risk factor and manual repositioning a common prevention strategy. This is an update of a review first published in 2014.
Objectives: To assess the clinical and cost effectiveness of repositioning regimens(i.e. repositioning schedules and patient positions) on the prevention of PI in adults regardless of risk in any setting
Search methods: We searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, and EBSCO CINAHL Plus on 12 February 2019. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies as well as reviews, meta‐analyses, and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication, or study setting.
Selection criteria: Randomised controlled trials (RCTs), including cluster‐randomised trials (c‐RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PI incidence in adults in any setting.
Data collection and analysis: Three review authors independently performed study selection, 'Risk of bias' assessment, and data extraction. We assessed the certainty of the evidence using GRADE.
Main results: We identified five additional trials and one economic substudy in this update, resulting in the inclusion of a total of eight trials involving 3941 participants from acute and long‐term care settings and two economic substudies in the review. Six studies reported the proportion of participants developing PI of any stage. Two of the eight trials reported within‐trial cost evaluations. Follow‐up periods were short (24 hours to 21 days). All studies were at high risk of bias. Funding sources were reported in five trials.